Cardiovascular disease hormone replacement therapy

Cardiovascular disease (CVD) is one of the leading causes of death worldwide. There are a number of established risk factors including serum cholesterol levels, smoking and family history, which are responsible for between 50 and 75% of the CVD cases, with the remainder due to factors that cause atherosclerosis. Estrogen treatment such as hormone replacement therapy is known to protect against CVD by decreasing the levels of low-density... 

Hormone therapy has proven highly effective in controlling the menopausal syndrome, especially severe hot flushes (MacLennan et al. 2004), even at doses significantly lower than those used until now (Speroff et al. 2000 Utian et al. 2001). Women s Health Initiative studies found that hormone replacement therapy, when administered as a primary prevention intervention for CVD in older women, increases the risk of heart disease and breast cancer. Even if a protective effect on fracture and colon cancer was observed, the risk-benefit ratio led to a recommendation of this treatment only for the short-term relief of menopausal symptoms (Rossouw et al. 2002 Anderson et al. 2004). The role of early administration of ovarian hormones to young postmenopausal women in the prevention of cardiovascular disease or late dementia remains... 

The clinical problems that arise in the menopause are hot flushes, sweating, depression, decreased libido, increased risk of cardiovascular disease and osteoporosis. The latter results in increased incidence of hip, radial and vertebral fractures. Oestrogen is one factor controlling synthesis of active vitamin D and osteoporosis is in part due to a deficiency of vitamin D. Not surprisingly, to reduce these problems, administration of oestrogen is recommended (known as hormone replacement therapy or HRT). HRT reduces some of the risk factors for coronary artery disease since it reduces blood pressure and decreases the blood level of LDL-cholesterol and increases that of HDL-cholesterol. However, there is considerable debate about whether HRT increases the risk of breast or endometrial cancer. 

Hormone replacement therapy provides relief from vasomotor symptoms, decreases the risk of osteoporosis and decreases the risk of cardiovascular disease in post-menopausal women. 

Rossouw JE. Hormone replacement therapy and cardiovascular disease. Curr Opin Lipidol 1999 10(5) 429-34. 

Lanzone A. The puzzle of hormone replacement therapy (HRT) and cardiovascular disease (CVD). J Endocrinol Invest 2002 25(l) l-3. 

Feigin VL, Wiebers DO, Nikitin YP et al. (1998). Risk factors for ischemic stroke in a Russian community a population-based case-control study. Stroke 29 34-39 Fine-Edelstein JS, Wolf PA, O Leary et al. (1994). Precursors of extracranial carotid atherosclerosis in the Framingham Study. Neurology 44 1046-1050 Gabriel SR, Carmona L, Roque M et al. (2005). Hormone replacement therapy for preventing cardiovascular disease in post-menopausal women. Cochrane Database Systems Review 2 CD002229... 

Male hormone replacement therapy has been reviewed (11). Hypogonadism can be accompanied by hot flushes, similar to those seen in postmenopausal women, and gynecomastia. The potential risks of testosterone replacement in adult men are precipitation or worsening of sleep apnea, hastened onset of clinical significant prostate disease, benign prostatic hjrperplasia, prostatic carcinoma, gynecomastia, fluid retention, polycythemia, exacerbation of hypertension, edema, and an increased risk of cardiovascular disease. 

Should we begin hormone-replacement therapy (intervention compared with no intervention) to prevent cardiovascular events (outcome) in this asymptomatic postmenopausal woman with a family history of coronary artery disease (patient) ... 

Pre-menopausal women suffer less cardiovascular disease than men do. This protection disappears, however, after the menopause, and hormone replacement therapy in post-menopausal women reduces cardiovascular mortality. Animal work suggests that oestrogens dilate blood vessels by an endothelium-dependent mechanism, but as yet there is no direct evidence to show that NO generation is different between men and women. This is an area of considerable interest, particularly as women have greater longevity than men and suffer less ischaemic heart disease. Abnormal NO production may occur in hypercholesterolaemia and may be related to subsequent development of atherosclerosis. There is now a body of experimental data to suggest that an abnormality in NO production or function may be causal, or at least an amplifying factor, in both hypercholesterolaemia and atherosclerosis. 

Miller AP, Chen YF, Xing D, Feng W, Oparil S. Hormone replacement therapy and inflammation interactions in cardiovascular disease. Hypertension 2003 42 657-663. 

Mohandas, B. and Mehta, R. 2007. Lessons from hormone replacement therapy trials for primary prevention of cardiovascular disease. Current Opinion in Cardiology 22, 434 42. 

Grady D, Herrington D, Bittner V, et al. Cardiovascular disease outcomes during 6.8 years of hormone therapy Heart and Es-trogen/Progestin Replacement Study follow-up (HERS II). JAMA 2002 288 49-57. 

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